[Influence of the analytical process in the appearance and disappearance of the spermatozoa after vasectomy]. / Influencia del proceso analítico en la aparición y desaparición de los espermatozoides del semen tras la vasectomia.

OBJECTIVES: To evaluate if the analytical process might justify that in some patients rare non motile sperm might be seen in some but not all their post-vasectomy semen samples. PATIENTS AND METHODS: Post vasectomy ejaculates received in our Center from january 2002 to december 2004 were reviewed. We used our own guidelines for post vasectomy semen assessment based upon those of the British Andrology Society for the evaluation of post vasectomy semen samples and the World Health Organization guidelines for semen analysis. RESULTS: During the 3 years of follow up, 984 patients underwent vasectomy. We received 1.430 semen samples, 2 samples per patient on average. Regarding the pre analytical phase, 134 samples (9.4%) were not completely collected; ejaculate volumes of less than 2 mL were delivered by 269 patients (18.8%); in these cases, we were not sure whether the whole ejaculates were submitted: pre analytical conditions of 11 samples (0.8%) were inappropriate: incorrectly labeled, spilled, provided into inadequate containers... Regarding the analytical phase, 432 ejaculates (30.5%) were extremely viscous and sperm detection might have been affected; 62 semen samples (4.3%) contained many cells which obstructed the visualization of the entire microscopy field. Regarding the post analytical phase, 153 patients (20.9%) had alternative negative/positive results with rare non motile sperm. CONCLUSION: An elevated percentage of incidences involving both the pre analytical and the analytical phase were observed during post-vasectomy seminal analysis. Inadequate conditions may affect the results and justify that spermatozoa may be seen in some but not all the ejaculates of the same patient. We recommend that two semen samples per patient are required to ensure that he is correctly evaluated. We propose to report a negative result as a spermatozoa count bellow the detection limit of our analytical procedure similar to other laboratory magnitudes to minimize the effect of fluctuations in such a low count of rare non motile sperm.

[Evaluation of guidelines for the assessment of success after vasectomy and needed improvements]. / Evaluación de un protocolo para el control de la vasectomía y modificaciones a realizar.

OBJECTIVES: The evaluation of a recently established guidelines about the assessment of semen samples after vasectomy in the laboratory of the Hospital General of Albacete and to modify them to optimize the number of semen samples provided per patient but keeping in concordande with the international recommendations. PATIENTS AND METHODS: The records of seminal analysis results from vasectomies performed from January 2002 to December 2004 were reviewed. Our vasectomy guidelines are based upon those of the British Andrology Society (BAS) and those of the World Health Organization for seminal assessment. RESULTS: During the 3 years 984 patients underwent vasectomy. At follow up, 67% of them returned postvasectomy semen samples, but just 55.,5% of them get the clearance criteria; the other patient abandoned before getting them. A mean of 2 samples per patient were received, but 39.6% of them provided one and more than 23% brought more than 3 semen samples. We had 43 technical failures, 4 early recanalization (0.5%) and one late recanalization (0.1%), and 13 patients underwent revasectomy (1,7%). CONCLUSION: A high percentage of our patients failed to fulfill the clearance criteria recommended by the BAS and almost a quarter of them had to deliver more than 3 semen samples. So we find convenient to modify our guides and propose that our patients should receive 2 request forms from the practitioner for semen analysis in the 6th and the 7th month postoperatively and should return to global evaluation of both reports. In that moment most patients will be able to meet the applied criteria for success with just 2 semen samples. Those who fail to become sterile because of either technical failure or early recanalizatione may be advised to go to the urologist with just 2 semen analysis without unnecessary delay.

Influencia del proceso analítico en la aparición y desaparición de los espermatozoides del semen tras la vasectomía / Influence of the analytical process in the appearance and disappearance of the spermatozoa after vasectomy

Objetivo: Evaluar si el proceso analítico puede justificar que en algunos pacientes se observen espermatozoides residuales en algunos de sus espermiogramas para el control de la vasectomía, pero no en todos. Material y métodos: Se revisaron los controles de las vasectomías realizadas desde enero de 2002 a diciembre de 2004. Nuestro protocolo consiste en una adaptación a nuestro medio de las recomendaciones de la Sociedad Británica de Andrología para el control de la vasectomía y de la Organización Mundial de la Salud para el análisis seminal. Resultados: Durante los 3 años del estudio se ha intervenido a 984 pacientes de vasectomía y se recibieron una media de 2 muestras por paciente. En relación a la calidad de la fase preanalítica, 134 pacientes (9,4%) refirieron no haber recogido todo el eyaculado; los volúmenes de semen fueron inferiores a 2.0 mL en 269 especímenes (18,8%) y existían dudas de que los eyaculados fueran completos; en 11 casos, las condiciones preanalíticas fueron incorrectas: contenedores mal etiquetados, derramados o inadecuados. Con respecto a la fase analítica, en 432 eyaculados (30,5%) se encontraron alteraciones de la consistencia; 62 especímenes (4,3%) contenían abundantes células y obstruían la visualización microscópica. En cuanto a la fase postanalítica, 153 pacientes (20,9%) obtuvieron informes con resultados alternativos de azoospermia y de presencia de espermatozoides residuales. Conclusiones: Se produce un elevado porcentaje de incidencias en la fase preanalítica y la analítica en los controles de los pacientes vasectomizados. Estas condiciones inadecuadas pueden afectar los resultados y justificar que los espermatozoides residuales se observen o no en los eyaculados de algunos pacientes. Recomendamos realizar un mínimo de dos espermiogramas por paciente para asegurar su correcta evaluación. Proponemos informar los resultados negativos como un recuento inferior al límite de detección de nuestra técnica de manera similar a otras magnitudes del laboratorio para minimizar el efecto de la fluctuación de los recuentos en estos niveles tan bajos

Objectives: To evaluate if the analytical process might justify that in some patients rare non motile sperm might be seen in some but not all their post-vasectomy semen samples. Patients and methods: Post vasectomy ejaculates received in our Center from january 2002 to december 2004 were reviewed. We used our own guidelines for post vasectomy semen assessment based upon those of the British Andrology Society for the evaluation of post vasectomy semen samples and the World Health Organization guidelines for semen analysis. Results: During the 3 years of follow up, 984 patients underwent vasectomy. We received 1.430 semen samples, 2 samples per patient on average. Regarding the pre analytical phase, 134 samples (9.4%) were not completely collected; ejaculate volumes of less than 2 mL were delivered by 269 patients (18.8%); in these cases, we were not sure whether the whole ejaculates were submitted; pre analytical conditions of 11 samples (0.8%) were inappropriate: incorrectly labeled, spilled, provided into inadequate containers... Regarding the analytical phase, 432 ejaculates (30.5%) were extremely viscous and sperm detection might have been affected; 62 semen samples (4.3%) contained many cells which obstructed the visualization of the entire microscopy field. Regarding the post analytical phase, 153 patients (20.9%) had alternative negative/positive results with rare non motile sperm. Conclusion: An elevated percentage of incidences involving both the pre analytical and the analytical phase were observed during post-vasectomy seminal analysis. Inadequate conditions may affect the results and justify that spermatozoa may be seen in some but not all the ejaculates of the same patient. We recommend that two semen samples per patient are required to ensure that he is correctly evaluated. We propose to report a negative result as a spermatozoa count bellow the detection limit of our analytical procedure similar to other laboratory magnitudes to minimize the effect of fluctuations in such a low count of rare non motile sperm